Provider Demographics
NPI:1225313000
Name:SUMMIT HEALTH SPECIALISTS, P.L.
Entity Type:Organization
Organization Name:SUMMIT HEALTH SPECIALISTS, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-220-5535
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-0518
Mailing Address - Country:US
Mailing Address - Phone:813-964-1401
Mailing Address - Fax:813-235-9753
Practice Address - Street 1:15511 N FLORIDA AVE
Practice Address - Street 2:SUITE B3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1263
Practice Address - Country:US
Practice Address - Phone:813-964-1401
Practice Address - Fax:813-235-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME572572085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty